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Premise Health was created when Water Street Healthcare Partners, a private equity firm, and Walgreens merged the latter’s onsite clinic business, Take Care Employer Solutions, with CHS Health Services to create a standalone company. In 2018, the company was sold to OMERS Private Equity.  

However, the organization’s history actually goes back farther than that, says Jami Doucette, MD, President of Premise Health. The forebearer entity that eventually turned into Premise Health ran an occupational health center in Manhattan for Random House publishing company during the 1960s. This particular center is still open and Random House is still a client, says Doucette. Moreover, many of the direct care companies that evolved into Premise merged in the 1980s, 1990s and into the 2000s, as the offerings focus went from occupational health to primary care.  

In 2021, Premise operates direct care clinics for employers and other payers with a mix of primary care, occupational health, pharmacy, wellness, musculoskeletal, behavioral health, and other services. The company has 11.5 million members, 850 physical wellness centers, and a digital wellness center. After acquiring CareHere, which operates wellness centers for self-funded employers, in late 2020, the company surpassed more than $1 billion in annual revenue.  

Recently, Premise Health announced it was expanding near-site health and wellness services in 10 markets across the U.S. including New York City, San Francisco, Washington DC, Chicago, Atlanta, Houston, Dallas Fort-Worth, Boston, Los Angeles and Phoenix. Health Evolution spoke with Doucette about the company’s expansion plans, how COVID changed the dialogue around virtual care, and more.  

How did the conversation around virtual care change in regard to your customers during COVID? 

We made a couple of strategic bets several years ago on digital as we transitioned our primary clinical platform over to Epic and we’re now actually the largest ambulatory instance of Epic on the planet. We also made a commitment to be one of their most digitally progressive clients at that time. And that meant several things to us. It meant multiple products in a virtual care environment. It meant device connectivity. It meant investing in a dedicated digital physician or provider team. And then honestly, we got lucky with our timing. Our dedicated digital provider team started January 2nd of 2020 and COVID hit in February. Rewind to pre-COVID, we were a typical provider organization, somewhere between 5-7 percent of our encounters were in a virtual environment. We peaked in April of 2020 with 85 percent of our encounters in a virtual environment. We’re now back around 35-ish percent in a virtual environment with material variability across our products. Behavioral health is still well above 70 percent in a virtual environment, but physical therapy is below 20 percent. Given the nature of how we get paid and our alignment with our clients and patients, we think the 35-40 percent range is where we’ll end up settling. 

From a client’s perspective, as the world has shifted in the last couple of years, the reality of how our members have accessed health care has shifted significantly as well. Prior to COVID, the on-site environment wasn’t incredibly powerful and convenient on those large campuses. In the beginning of COVID, virtual was the dominant conversation piece. We’ve seen kind of a settling out of virtual, but we’ve also seen a material rise in the demand for near site centers. As we think about large self-funded entities wanting to take greater control of their medical spend…doubling down on where the majority of that spend occurs has been critical in those strategies. Providing that segment of the population with access to this model in the communities in which they live, coupled with virtual care, has been a critical component in those clients’ perspective and strategies going forward.